Doctors and physical therapists have long included aerobic exercise in treatment programs for back pain. Exercise can relieve back pain and strengthen the muscles that support the back. Yet many people with back pain are hesitant to exercise.
A new study published Wednesday in The Lancet provides further evidence of the power of exercise. It found that a regular walking habit is highly effective in preventing the recurrence of back pain. In the study, which looked at adults with a history of back pain, those who walked regularly lived almost twice as long without their back pain recurring compared to a control group.
The findings are consistent with numerous existing studies that have found a link between physical activity and improved back pain. A 2019 systematic review found that physical activity reduces the prevalence of back pain, and a 2017 study found that yoga was as effective as physical therapy in relieving back pain.
The new study builds on that work by following patients outside of tightly controlled clinical settings, said Mark Hancock, a professor of physiotherapy at Macquarie University in Australia and lead author of the study, who sought to evaluate the effectiveness of a cheaper intervention that is more accessible to many people than in-clinic treatment.
Hancock and his team targeted a relatively sedentary sample group. The researchers collected data on 701 adults who had recently recovered from back pain. They randomly split the subjects into two groups: one group received an individualized walking and education program led by a physiotherapist over six sessions over a six-month period; the other group received no intervention. The researchers then followed both groups for one to three years.
The goal for each person in the walking group was to walk at least 30 minutes per day, five times per week, but the program was highly personalized based on age, BMI, current activity level, time constraints, and individual goals.
Participants in the walking group also received an education program to help them better understand and manage their pain. If patients’ back pain worsened, they were encouraged to continue walking, but to adjust their speed and distance as needed. Dr Hancock said many people tend to avoid moving when their pain worsens, especially when it comes to protecting their backs.
“Education has changed their mindset and helped them become more active and stay active despite their back pain,” Hancock said.
The new findings are consistent with the conclusions of a 2020 meta-analysis of 25 studies on back pain prevention, which Hancock co-authored, in which researchers found that combining regular exercise with physical education was the most effective way to prevent recurring back pain.
Back pain can have many causes, but the underlying cause is often a “weak base of support,” says Hamza Khalid, M.D., of the Cleveland Clinic’s Center for Spine Health. Walking helps strengthen the muscles that stabilize your spine, especially your core muscles. A weak core can lead to fatigue, misalignment of the spine, and pain, he says.
Hancock’s research has found that nearly seven in 10 people who recover from back pain will experience a recurrence within the following year.
“Exercise is like medicine,” Khalid says, but emphasizes that it’s “not a magic pill.” If your back pain is chronic or complex, your doctor or physical therapist can help you create an exercise program tailored to your specific needs.
Still, physical activity likely helps: At this point, “the evidence is pretty overwhelming,” Hancock said.
